]]>Flip-flops look and feel great at the beach and concerts in the park. But the relaxed footwear can strain muscles and aggravate nerves in the feet and ankles when worn too long or if playing sports.

So go ahead and step out in your favorite flip-flops for summertime strolls and parties. (P.S. Be sure to protect your feet with sunscreen.) Then, step into well-cushioned shoes when walking on concrete or pavement and exercising to dodge painful problems, say Mount Sinai School of Medicine Orthopaedic doctors who treat an influx of flip flop injuries each summer. Here’s why!

Flip-flops offer limited support.

People grip and hold flip-flops in place with their toes. Result: This motion changes the way you walk and can stress the toes, ankles, legs, hips, and back.

Few people understand or think of the foot as a place where skin cancer can arise. Result: Foot melanoma can be deadly. Mount Sinai Podiatrist Dr. Bryan Markinson reports a sharp rise in foot melanoma among his patients. Alert to sandal wearers: Remember to apply sunscreen to your feet!

]]>Stylish UGGs—Australian sheepskin-lined boots—are a popular favorite of men, women, and kids to keep feet warm and dry during the chilly weather. Follow these simple tips from New York podiatrist Dr. Krista Archer, an Associate of the American College of Foot and Ankle Surgeons, to keep feet healthy, too.

1. Consider a supportive insert. UGGs are super-comfortable for many, but a lack of arch support and loose fit can sometimes cause tendonitis and heel pain.

]]>http://www.saturdayeveningpost.com/2011/01/15/health-and-family/medical-update/dos-donts-ugg-boots.html/feed1Good News for Bad Ankleshttp://www.saturdayeveningpost.com/2010/06/02/in-the-magazine/health-in-the-magazine/good-news-bad-ankles.html
http://www.saturdayeveningpost.com/2010/06/02/in-the-magazine/health-in-the-magazine/good-news-bad-ankles.html#commentsWed, 02 Jun 2010 20:43:45 +0000http://www.saturdayeveningpost.com/?p=21717What you need to know about ankle replacement and one man's intense journey to get back on the golf course.

]]>People simply don’t think too much about their feet; their ankles even less so. But as far as joints go, the ankle is decidedly one of the most crucial and complex. The intricate hinge not only supports the body, but allows for a wide range of motion and versatility—from running and walking, to jumping and dancing. That is, until something goes awry.

For the nearly 50,000 Americans seeking relief each year for debilitating bone-on-bone ankle pain and disability, there’s good news. Recent advances in arguably the most intriguing area of orthopedic surgery—total ankle replacement—are making strides in restoring mobility and quality of life to patients.

Today, four total ankle replacements are used in the U.S.: the Agility, the Inbone, the Salto Talaris Anatomic Ankle, and the Scandinavian Total Ankle Replacement (STAR).

“The technology is light years ahead of where it was a decade ago,” says Dr. Robert Anderson, an orthopedic surgeon in Charlotte, North Carolina, who performed more than 40 Inbone procedures in the past two years and is part of a design team working on a second-generation device.

Hi-tech artificial ankles provide a new alternative to surgery, which permanently fuses worn-out joints. That procedure reduces ankle pain but often limits mobility, causes a limp, and can lead to arthritis in nearby foot joints. An estimated 25,000 Americans underwent ankle fusions in 2009; others considered even more drastic measures.

Reasons for needing an ankle replacement include wear-and-tear over time, accidents, sports injuries, and bone diseases that lead to severe and life-limiting arthritis.

Four years ago, Jeanne St. John’s ankle problems led her to the brink of a difficult decision.

“I was born with deformed ankles and, eventually, was so immobilized by arthritis that I considered a double amputation,” recalls St. John, who lives in Oregon. “Then a friend heard about the Inbone. It’s been life-changing for me.”

As with hip and knee replacements, the history of total ankles dates back to the 1970s. Healthy ankles can withstand 1.5 times one’s body weight while walking, but early devices didn’t hold up. Then, Dr. Mark Reiley—who performed St. John’s surgeries in the San Francisco Bay Area—devised a new way to replace the complex joint.

“Dr. Reiley took the proven technology of knee replacements and basically flipped it upside down to be used in the ankle,” Dr. Anderson describes. “The device, now called the Inbone, has very good mechanical advantages and can be used for primary replacements, as well as revisions of failed or previously placed devices. We believe it will be successful for a long time.”

Orthopedic surgeons select the specific ankle replacements depending on patient age, anatomy, bone quality, and goals. Long-term success rates on Inbone are not yet available; European data show that 85 percent of modified Salto and STAR devices are functioning well after 10 years.

But Jeanne St. John, now age 67, prefers to focus on how far her new ankles take her.

“I think in terms of steps rather than years,” she says. “I save my steps for selected activities and for travel. Some of my friends are slowing down, but I have this ‘reverse aging’ thing going on, and I’m so thankful.”

Back on the Green

Post: What initially happened to your ankle, and when did you have replacement surgery?

McAvoy: The first of many injuries to my right ankle occurred when I was a 16-year-old high school basketball player. Thinking back, we wore very ill-fitting sneakers and re-injury was common. I just sucked it up and kept plugging along. Eventually, however, it was hard to even walk to the kitchen. I had ankle replacement surgery in April 2008.

Post: What was life like after the initial injury?

McAvoy: I actually went to college on a golf scholarship. After graduation, I coached basketball and tried to run for about 20 years. My approach to running was: adapt and overcome. I would hit the ground with my left leg and then the toes of my right leg. In my 40s, a doctor pointed out that my left calf was almost 2 full inches larger than my right calf. I was basically dragging my right leg.

Post: Did problems develop inside your ankle joint?

McAvoy: Absolutely. I had severe osteoarthritis, and the surrounding ligaments were no longer able to protect the joint. I would step on a stone and fall down. And as I got older, new bone tissue grew over the top of the joint and basically eliminated all ankle movement.

Post: How did you hear about ankle replacement surgery?

McAvoy: In 2005, I had ankle surgery at Coordinated Health (CH) in Lehigh Valley to shave away excess bone and create space within the joint. It helped for a while, but then the bone grew back, and doctors said my only option was ankle fusion. In 2008, I went back to CH for an ingrown toenail and saw Dr. Stephen Brigido. He asked about my ankle and said he could help me with a new technology called the Inbone ankle replacement. I believed him, and we scheduled the surgery.

Post: How has your life changed?

McAvoy: My quality of life is greatly improved because of the implant and Dr. Brigido. I walk normally—and without the pain and noticeable limp that I had for many years. I don’t run, but I walk three to five miles a day with my Border collie. I’m also able to walk on a golf course, and my game has improved because I can push off better from my right side.

]]>http://www.saturdayeveningpost.com/2010/06/02/in-the-magazine/health-in-the-magazine/good-news-bad-ankles.html/feed1Skin Problem Could Be Eczemahttp://www.saturdayeveningpost.com/2009/04/17/health-and-family/medical-mailbox/skin-problem-eczema.html
http://www.saturdayeveningpost.com/2009/04/17/health-and-family/medical-mailbox/skin-problem-eczema.html#commentsFri, 17 Apr 2009 23:00:43 +0000http://www.saturdayeveningpost.com/?p=3799Dear Dr. SerVaas, My husband (age 62) has red spots on both feet. They are not bothersome unless they form blisters under the toes that later peel. The mystery is that he also had this problem last winter. When warm weather came they totally disappeared. He just had a complete blood work up and everything […]

]]>Dear Dr. SerVaas,
My husband (age 62) has red spots on both feet. They are not bothersome unless they form blisters under the toes that later peel. The mystery is that he also had this problem last winter. When warm weather came they totally disappeared. He just had a complete blood work up and everything is normal. Any thoughts?

“Your husband’s symptoms are most commonly associated with a type of eczema called dyshidrotic eczema that results from lack of moisture in the skin caused by seasonal changes to cold, dry temperature, frequent skin washing, and indoor heating which decreases skin moisture.

“Treatment includes minimal use of soap, applying over the-counter emollients (ointments are better than creams and lotions which are water-based) and, when severe, the use of prescription strength topical steroids. Early diagnosis and treatment is important to prevent the development of open foot sores that may progress to chronic wounds.

“Dyshidrotic eczema is also called pompholyx, a term that derives from cheiropompholyx meaning ‘hand and bubble’ in Greek. Patients typically present with itchy bumps that progress to water blisters on the sides of the hands and feet in a near symmetric distribution.”

]]>http://www.saturdayeveningpost.com/2009/04/17/health-and-family/medical-mailbox/skin-problem-eczema.html/feed2Find the Perfect Shoehttp://www.saturdayeveningpost.com/2009/04/17/in-the-magazine/living-well/find-perfect-shoe.html
http://www.saturdayeveningpost.com/2009/04/17/in-the-magazine/living-well/find-perfect-shoe.html#commentsWed, 30 Nov -0001 00:00:00 +0000http://72.3.135.59/wordpress/?p=2865Try these on for size: nine steps every woman should take when shopping for the right fit.

About 75 percent of the nearly 800,000 surgeries performed for bunions and the other most common foot problems are caused by poorly fitting shoes, according to the American Orthopedic Foot & Ankle Society.

Start by having both feet measured. Some people’s feet change sizes as they age, have children, gain or lose weight, or change physical activities.

Because most people have one foot larger than the other, be sure you pick a shoe that fits your larger foot comfortably. You can always add an insert or pad to the shoe for the smaller foot.
Shoe sizes are not universally standardized. “Different brands and different styles within a brand will fit differently,” Harris says. “A shoe labeled 8 ½ may fit like an 8 or may fit like a 9.” The half-size of a shoe is only one-sixth of an inch.

Even with a company like Munro that makes 75 different sizes per style to ensure the right fit, the same woman may wear different sizes in different styles because of the shape of her foot.
“Most of our customers can wear all of our shoes in the same size, but not all of our customers can,” Harris says. If someone has a high instep, for example, she may have to wear a different size for a low-cut pump than she would for a boot.

Select shoes that conform to the shape of your foot. You can still wear a pump that fits comfortably, as long as you don’t try to squeeze your toes into the point. The widest part of your foot should fit into the widest part of the shoe. “You’re going to have to have some room at the end.”

That half-inch space between the end of your toes and the shoe isn’t just for kids. Harris says everyone should have up to half an inch between their longest toe and the end of the shoe.

Slippage is good—just not too much. As we walk, our feet have to have room to bend within the shoes. If you don’t have enough room, you’ll get blisters or “pump bumps,” calcium deposits caused from chronic irritation or rubbing. “If you cannot pull your heel out of a shoe while standing, the shoe is probably too short or narrow.”

The shoe should feel comfortable when you walk around the store. If it hurts in the store, it’ll hurt when you wear it.

Try to recreate the conditions under which you’ll be wearing the shoes. If you’re the kind of person who is on your feet all day, your feet swell as the day goes on. So it’s best to try on shoes in the evening.

If you wear orthotics, take them with you for your fitting. “The slightest difference from the insert or insole can have a drastic effect on the fit of your shoes,” he says. Orthotics affect the size and fit of a shoe, so if you buy shoes without seeing how they fit with the orthotics, “it could completely defeat the purpose of the orthotics.”

Try on shoes with the same type or weight of socks you’ll be wearing with the shoe. For example, don’t wear trouser socks to try on dress shoes if you’ll be wearing the shoes with nylons. And don’t wear nylons to try on athletic shoes. “They need to fit in the same environment in which you need the shoes,” he says.

And to get the most life out of your shoes, Harris advises never to never wear the same shoes two days in a row, so they can dry out naturally.